Lyndsay Glenn and Jean Lauro are the home front's walking wounded of war.

They, and others who care for veterans with post-traumatic stress disorder (PTSD), may not have been in combat, but they can wage much the same battles, suffering similar psychic wounds, as those who have.

Their common "enemies" are anger, frustration, isolation, anxiety and a variety of other psychiatric problems.

Glenn struggles to maintain a household -- caring for both her husband, a Marine who served in Iraq, and their 2-year-old daughter, with little time for herself.

She never signed on to be the collateral damage of a disorder that can seem overwhelming and has no cure.

"Sometimes I don't feel like my vows cover this horror," she said.

Lauro had her own nightmares, tears and constant worry as the mother of a daughter who came home psychologically shattered after a tour with the Army in Iraq. Lauro called it "living on the edge." Every day.

PTSD isn't a death sentence for veterans. But it can be a life sentence for their families.

Often there's a spillover effect, impacting anyone personally involved with this disorder -- spouses, parents, and even children.

This "secondary PTSD" can include distress, depression and anxiety, said the Department of Veterans Affairs' National Center for PTSD.

Wives of veterans with PTSD are twice as likely to get divorced, and face a higher risk of domestic violence, than spouses of vets without the disorder, the VA notes.

A RAND Corporation report issued earlier this month noted, "Researchers have found that caregivers of veterans with PTSD experience a burden of care on a par with caregivers of individuals with dementia and chronic schizophrenia."

Studies cited in the report show that caregivers experience high levels of physical strain and mental health problems. These include coronary heart disease, hypertension, reduced sleep and depression.

Veterans and their spouses have seen how PTSD affects their children, who can react with fear, isolation and anger, or develop their own psychological symptoms mimicking the disorder.

For PTSD couples, resolving these issues starts with the realization that life will never be the same, according to Dr. Edgardo Padin-Rivera, head of psychological services at the Louis Stokes Cleveland VA Medical Center.

"The old 'normal,' that's gone now," he said. "They're going to have to start working on a new normal."

More families will face the challenges posed by a condition that has been tagged with several names through history -- from "soldier's heart" of the Civil War and "shell shock of World War I," to "battle fatigue" of World War II and "stress response syndrome" during the early years of the war in Vietnam.

"We're seeing a higher rate of PTSD and other problems [among veterans] such as depression and substance abuse, which are all interrelated," said Padin-Rivera.

The impact of secondary PTSD among the families of current vets may be delayed as they try to resume a "normal" life and sublimate their war experience under work or other activities, said Beachwood psychologist Walter Knake, who has worked with vets with PTSD since the Vietnam war.

"They might try to ward-off working through the issues," he noted. "Sometimes it takes a while for this stuff to start happening."

Knake said much the same delayed-response occurred with Vietnam vets who were able to bury their war issues under work or raising a family until they retired and the kids moved on. Suddenly they had too much time to think about the past, and the repercussions hit in the form of PTSD.

Families of Vietnam veterans with PTSD have dealt with the burden for decades. Now, loved ones of veterans who served in Iraq and Afghanistan are discovering the same challenges regarding this lingering, invisible wound of war.

Of the 2.3 million troops deployed to Iraq and Afghanistan since 2001, more than 18 percent suffer from PTSD, major depression, or both, said the National Council for Behavioral Health.

Currently, more than half of active duty troops are married, and 44 percent have children -- illustrating the potential impact of secondary PTSD.

Iraq/Afghanistan veterans represented 19 percent of the VA's PTSD patients two years ago. Last year it was 24 percent.

The VA has responded by hiring an additional 1,281 mental health clinicians and staff, and will continue to re-assess their resources to meet future demands, according to Sonja Batten, the VA's deputy chief consultant for mental health services.

She also noted that in recent years the VA has placed an increased emphasis on training staff to provide help for veterans' families who represent "a really important component" of recovery.

Some families have spent years living with the nightmares, depression and anger of a veteran's PTSD, while desperately trying to find ways to cope.

Others are just getting started.

Living a different 'normal'

"It's beyond stressful," said Lyndsay Glenn, 28, whose husband, Jimmy, was medically discharged because of a traumatic brain injury and PTSD from two tours in Iraq as a Marine combat engineer.

Finding a new normalEver since Jimmy Glenn returned from Iraq with post-traumatic stress disorder, his wife, Lyndsay, has to shoulder the responsibilities of caring for him and their 2-year-old daughter, plus handling the household. "It's beyond stressful," she says.

"Some days he's really aggressive, some days he has violent thoughts, and sometimes he can barely make it out of bed," she said. "You watch him suffer and try to help. It's an exhausting thing to have to deal with.

"It's something that has forever changed our lives."

Lyndsay remembered his headaches when they first met in Myrtle Beach, N.C.

Jimmy, now 26, was being treated for lingering effects of an injury caused by being close to blasts from improvised explosive devices.

After they got married, she noticed he got angry a lot, and refused to leave home. When he was diagnosed with PTSD, they moved to Northeast Ohio where her family could help both with his care and with the couple's baby girl.

Lyndsay has cut back on a full-time career in hospitality management. She assumed responsibility for caring for both Jimmy and her daughter, plus handling household finances, cooking, cleaning and transportation.

It isn't how marriages are supposed to work, she said. "It's frustrating from the aspect that you think you're supposed to have somebody who's just as helpful, and that's not how it is."

For a while Jimmy improved to the point of venturing out to "safe zones" such as nearby stores, or her parents' house.

Then last July, when they took their daughter to a carnival where there were fireworks, "he just snapped," she said. "He came out with the realization that this is real, and he can't handle it. Ever since then it's been a downward spiral."

"Emotionally, I'm more of a wreck than before," she said. "It's a constant 24/7 job. There's never really any me-time. I never get a day when I can take a break.

"Quite often I reach a point where I have to ask myself, 'How can I do this the rest of my life?' "

Her father has noticed the strain. "It definitely puts pressure on her," said Dan Zamiska, 58, of Fairview Park. "She's basically got to do everything, but she's got a good attitude about it."

Zamiska said he'll often lend a hand -- babysitting or spending time with Jimmy when he's having a bad day. "Things we take for granted are difficult for him," he said.

The situation wasn't what he expected when the couple got married. "As a father, you want to see the best for your daughter, but he [Jimmy] is a good kid," Zamiska said. "He treats my daughter well, and he's always looking to get help. He wants to change. I can't blame him for something he can't control."

The toll on Lyndsay includes problems sleeping. Sometimes she is awakened by her husband's tossing and turning. "Then I get stressed out because I haven't gotten any sleep," she said.

She's concerned that his behavior might be affecting their daughter. "His aggression has gotten worse. He's not violent in a physical way, but he'll snap a lot easier and yell," she said. "She does pick up on that and has started to take more to me than him, so we have to work more on that."

At times, she gets depressed. "Very, very much so," she said.

Madelyn Glenn watches TV with her father, Jimmy, who wonders how his battle with PTSD is affecting her. Though he says, "I don't want to hide nothing from her," he hopes she never asks what happened to him during the war.Gus Chan, The Plain Dealer

She's worried about Jimmy's depression, too, because she's heard PTSD can be a factor when veterans kill themselves.

Suicides among active duty U.S. military personnel in 2012 (349) exceeded the number of troops killed in combat (310) that year. Study results vary as to the role of PTSD in suicides by all veterans -- estimated by the VA to run upwards of almost 8,000 a year.

Most veterans who commit suicide have not seen combat. But the VA said those who were deployed to Iraq and Afghanistan and have been diagnosed with a mental health condition are four times more likely to kill themselves than veterans without that diagnosis.

Suicide is a common concern among couples coping with PTSD, said Padin-Rivera, of the Cleveland VA Medical Center. His own uncle came home from the Korean War and shot himself to death.

Padin-Rivera said families should look for such risk factors as heavy drinking, not wanting to be around people and weapons in the house.

Other PTSD issues affecting loved ones include a lack of intimacy and problems arising from different views of parenting and finances, Padin-Rivera said.

The psychologist said a combat veteran's need to control their environment, heightened by hyper-vigilance developed in war, also creates friction.

He noted the impact of a veteran's behavior on children can include a child acting out in school, hiding -- "they may be scared to be around him" -- and trying to isolate themselves from the family by staying away from the house.

A 2010 Department of Defense report on the impact of deployment on military families cited studies showing that children of a parent in the service with PTSD displayed significantly more emotional problems including anxiety, withdrawal and depression. The same pattern was seen among children of spouses with secondary traumatic stress syndromes.

Padin-Rivera said that through counseling, couples can learn how to talk and work out their differences without judgment, how to broach certain subjects and when to back off, and make sure that caregivers get support and guidance.

Though the Glenns continue to struggle with his PTSD, there have been small victories and lessons learned.

They recommend counseling for both husbands and wives. "You have to have somebody to talk to. You can't do it alone," said Jimmy.

Lyndsay has attended retreats offered by the Wounded Warrior Project for wives of veterans with PTSD. "It helps to know that somebody else has gone through it," she said. "It's literally like, 'I'm not the only one. I'm not crazy.' "

Open communication is a must. "That's the biggest thing," she said. "I have the right to share with him how I feel, as much as he has the right to share with me. "

Recently, just before Jimmy left to attend a residential PTSD treatment program, she said, "I hope he gets better, but I'm not holding my breath.

"I'm excited that I'll have some time for myself," she added, while cutting chicken chunks in her kitchen. "I won't lie about that. I'll be able to think for two, instead of the three of us."

Jimmy hovered nearby for several minutes, waiting to speak with her. He finally said, "All right, are you going to pay attention?"

For now, patience and perseverance are not only virtues, they're survival skills.

"No matter what you're going through, you don't give up," Jimmy said.

Counselors have told them "we have a different normal than everybody else, and that's just the way it is," Lyndsay said. "That's OK. You just have to accept it.

"There are some days that are going to be good, some days are going to be horrible, and some days that are going to be OK," she added.

"But no day is ever going to be the same again."

Sharing a daughter's burden

When Natalie Robbins joined the Army Reserve in 1998 to earn money for education, she asked to be put in the least deployable job possible. She became a fabric repair specialist and was assigned to laundry/shower maintenance duties.

"And guess what, she was the first to deploy," said her mother Jean Lauro, 61, of Sheffield.

Lauro said she had offered to work extra hours -- "for the rest of my life, if need be" -- to pay for her daughter's degree, rather than see her in the service.

Jean Lauro gives Natalie Robbins a hug and says the best way she found to help with her daughter's PTSD was to "support her, love her and be there for her."Lonnie Timmons III, The Plain Dealer

Her misgivings turned out to be justified. Robbins, 36, said that during her 2003-2004 deployment to Iraq, she was sexually assaulted and raped by two fellow soldiers.

(VA and Department of Defense reports indicate that 20 percent of female veterans who served in Iraq and Afghanistan are victims of military sexual trauma; an estimated one in three women veterans have been sexually assaulted.)

When Robbins came home, she burned much of the things relating to her service. "I had to hide everything else," her mother said. "She didn't want to think about any of that stuff."

Robbins called it a purging, but the mental scars remained.

Her mother recalled, "I realized pretty quick that she didn't want to talk about it. She started acting moody. She would hide out, go for walks in the woods.

"She came back pretty isolated, as far as emotions go," she added. "It got to the point where I didn't know what I could say. I was afraid certain things would set her off. So many times I'd say the wrong thing and she'd snap at me.

"I never stopped being a mom, so I got yelled at a lot."

"A strain? Oh my God, yeah," Lauro said. "I lived on the edge every day. I worried so much about wanting her to get better, and feeling so helpless.

"It was a horrible thing for a parent not to be able to fix stuff," she said. "I was a wreck most of the time."

Lauro said she had nightmares, and at one point feared the worst when her daughter told her that she had "just told God to take her, because she couldn't take the pain anymore."

Robbins, now living in Berea, went into VA counseling for her PTSD -- a condition that she said resulted from the assaults that she kept secret for fear of retribution, and her own shame.

Then, "one day she just jumps in her car and goes to Washington state," her mother recalled. "When she left she had no idea where she was going. That's just where she ended up."

Robbins returned with a dog, Kindred, that became a key part of her recovery.

Kindred keeps her grounded, Robbins said. "There's no disappointments, no trust issues with a dog," she added.

Robbins' mother said she came to realize the best approach in dealing with her daughter was "don't ask questions, just support her, love her and be there for her."

And "if you have to fall apart, wait until they're not around," Lauro said. "Cry, yell, scream, whatever you want to do. But not in front of them. They need you to be strong for them."

Robbins noted that in dealing with a veteran with PTSD, "unconditional love is the biggest thing, through your words and actions. Consistency, too. I know I can count on her."

Don't probe or push for answers, both women said. A veteran will talk when the time feels right.

Robbins said she's on the road to her"new normal." She'll graduate from Baldwin Wallace University this year with a degree in exercise science.

There's less anxiety and depression now, Lauro said, because "I don't have to worry about her so much. She's on a good path."

Now mom can concentrate on just being the self-described "official dog-sitter-in-chief."

It's part of being there for her daughter. "Always," Lauro said. "Always."

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